[this lecture is a continuation of the breast conditions lectures] adenomas are highly glandular benign masses that are the most commonly presented benign tumors of the breast. a fibroadenoma is well encapsulated by fibrous tissue and is generally firm and freely movable. microscopically, they might have hyperplasia of intraductal epithelial cells. fibroadenomas grow and diminish according to hormonal influences, in particular growing during pregnancy and late menses and regressing after menopause.
breast cancer generally presents as a firm, fixed mass associated with skin dimpling, nipple retraction and discharge. some high risk factors include old age, a positive family history, alcoholism, and some hormonal indicators (high IGF-1 levels premenopause and high estrogen levels post menopause). lower risk but still significant factors include smoking, a late first pregnancy, history of other benign lesion. in general, risk for breast cancer increases with lifetime exposure to estrogen, which by virtue of its cell proliferating effect can increase the likelihood of cell mutation that can lead to cancerous cell lines.
there are several types of breast cancer, the most prominent being intraductal or infiltrating ductal carcinoma, which makes up ~80% of breast cancers. this is characterized by a single hard mass with irregular borders that is not easily movable. second most common, 5-10% is lobular carcinoma which is characterized by multiple foci in affected breast and increased risk for bilateral involvement (histological findings might include "signet ring cells"). the least common form is paget's disease of the nipple, which might cause a persistent burning/itching sensation, lead to eczematous changes of the skin, and ultimately to ulcers and destruction of the nipple. inflammatory breast cancer is an uncommon type of ductal carcinoma that involves aggressive inflammation of the affected breast and is notable for sometimes not presenting with a palpable mass during physical examination.
questions
adenomas...
1. what is an adenoma vs. an adenosis?
2. what is the most common benign tumor of the breast?
3. what is the clinical presentation of a fibroadenoma?
4. what are the histological findings of a fibroadenoma?
5. fibroadenomas might increase in size in response to what influences?
6. are fibroadenomas benign or malignant?
intraductal papilloma...
7. how common is an intraductal papilloma?
8. intraductal papilloma is the most common cause of...
breast cancer...
9. what tissue does most breast cancer appear in?
10. what are some "high" risk factors for breast cancer?
11. what are some "medium" risk factors for breast cancer?
12. what are some factors that can protect against breast cancer?
13. what is one common denominator in the risk factors for breast cancer?
14. describe estrogen's role in the pathogenesis of breast cancer.
15. describe pregnancy's role in decreasing susceptibility to breast cancer.
16. what are the PE findings commonly associated with breast cancer?
17. what are the three main types of breast cancer?
types of breast cancer...
18. what is the most common type of breast cancer? how common is it?
19. what is IDC characterized by?
20. what is the second most common breast cancer and how common is it?
21. LC is associated with...
22. how common is paget's disease of the breast?
23. what is a common presentation of paget's disease?
24. how does the paget's disease present in its later stages?
25. what is inflammatory breast cancer?
26. what is notable about the PE of IBC?
answers
1. adenosis is increased glandular component aggregation while adenoma is a more organized but still benign form.
2. fibroadenoma.
3. generally a non tender, firm, freely movable mass.
4. well encapsulated, with hyperplasia of intraductal epithelial cells.
5. hormones during pregnancy and late menses.
6. generally benign with an miminally increased risk for carcinoma.
7. found in 1-3% of all biopsy specimens.
8. spontaneous nipple discharge from a single duct.
9. glandular tissue (includes both lobular and ductal tissue).
10. old age, prior history of breast cancer, positive family history (especially if mother and sister both had breast cancer), alcoholism, high IGF-1 levels premenopause, high estrogen levels postmenopause. [old history family alcohol insulin estrogen] [the old story of my family involves alcohol and hormones]
11. a late first pregnancy or nulliparity, family history, smoking, history of other benign lesion.
12. late menarch, breast feeding, exercise, low alcohol/tobacco, diet rich with monounsaturated fats.
13. most involve lifetime levels of endogenous estrogen exposure.
14. because estrogen has a cell-proliferating effect, it inherently increases the possibility for gene mutations to occur, which cause breast cancer.
15. pregnancy decreases the breast tissue susceptibility to mutation (unknown reasons) and thus can shorten the "susceptibility period" that begins at menarche.
16. firm, fixed, not painful, irregular borders, skin dimples, nipple retraction, galactorrhea.
17. ductal/intraductal, lobular, Paget's disease of the nipple.
18. infiltrating ductal carcinoma. 80% of breast cancers.
19. single hard mass with irregular borders, not easily movable.
20. lobular carcinoma, 5-10%.
21. multiple loci in affected breast, increased risk for bilateral involvement.
22. uncommon compared to ductal and lobular.
23. persistent change in sensation of nipple, itching/burning. might have eczematous changes on overlying skin.
24. may present much differently than earlier stage: with ulceration and destruction of nipple.
25. a form of ductal carcinoma that is characterized by aggressive inflammation of the affected breast.
26. might present without a palpable lump.
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